U.S. patent number 7,458,975 [Application Number 11/018,457] was granted by the patent office on 2008-12-02 for method of replacing an anterior cruciate ligament in the knee.
This patent grant is currently assigned to Johnson & Johnson. Invention is credited to Thomas C. May, Gregory Whittaker.
United States Patent |
7,458,975 |
May , et al. |
December 2, 2008 |
Method of replacing an anterior cruciate ligament in the knee
Abstract
A method of reconstructing a ruptured anterior cruciate ligament
in a human knee. Femoral and tibial tunnels are drilled into the
femur and tibia. A transverse tunnel is drilled into the femur to
intersect the femoral tunnel. A filamentary loop is threaded
through the femoral tunnel and tibial tunnel and partially through
the transverse tunnel. A replacement graft is formed into a loop
and moved into the tibial tunnels using a surgical needle and
suture. A flexible filamentary member is simultaneously moved along
with the loop into the femoral and transverse tunnels. The
filamentary member is used as a guide wire in the transverse tunnel
to insert a cannulated cross-pin to secure a top of the looped
graft in the femoral tunnel.
Inventors: |
May; Thomas C. (Wrentham,
MA), Whittaker; Gregory (Stoneham, MA) |
Assignee: |
Johnson & Johnson (New
Brunswick, NJ)
|
Family
ID: |
36641636 |
Appl.
No.: |
11/018,457 |
Filed: |
December 21, 2004 |
Prior Publication Data
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|
|
|
Document
Identifier |
Publication Date |
|
US 20060149283 A1 |
Jul 6, 2006 |
|
Current U.S.
Class: |
606/53;
623/13.14; 606/232; 606/60; 606/329; 623/908; 623/911; 128/898 |
Current CPC
Class: |
A61B
17/1764 (20130101); A61B 17/1714 (20130101); Y10S
623/911 (20130101); Y10S 623/908 (20130101) |
Current International
Class: |
A61B
17/56 (20060101); A61B 17/04 (20060101); A61F
2/08 (20060101) |
Field of
Search: |
;623/13.14-13.17,908,911
;606/53,60,300,301,329,86R,232 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Primary Examiner: Gherbi; Suzette J
Claims
We claim:
1. A method of repairing a knee, comprising: providing an anterior
cruciate ligament replacement graft having opposed ends; drilling a
longitudinal tibial tunnel through a top section of a tibia, the
tibial tunnel having a top opening and a bottom opening; drilling a
longitudinal femoral tunnel through a bottom section of an adjacent
femur such that the tibial tunnel and the femoral tunnel are
substantially in alignment, wherein said femoral tunnel has a
bottom opening and a top opening; drilling a substantially
transverse tunnel through the femoral tunnel, such that the
transverse tunnel intersects the femoral tunnel, and is in
communication therewith, the transverse tunnel having first and
second open ends; providing a filamentary member, wherein said
filamentary member comprises an endless loop; threading the
filamentary member through the knee such that a first loop segment
of the filamentary member extends out from one end of the
transverse tunnel and a second loop segment of the filamentary
member extends out through a bottom opening of the tibial tunnel;
providing a surgical needle and attached surgical suture; folding
the graft to form a graft loop having a top, a bottom, and an
opening; engaging the graft with the suture such that the suture
passes through the graft loop opening; engaging the graft with the
filamentary member such that it passes through the graft loop
opening; pulling the graft loop up and into the tibial tunnel by
pulling on the needle and suture, such that the top of the graft is
outside of the tibial tunnel adjacent to the bottom opening of the
femoral tunnel, and the second loop segment of the filamentary
member is also outside of the tibial tunnel; adjacent to the bottom
opening of the femoral tunnel cutting the first loop segment of the
filamentary member to form first and second ends, and manipulating
the filamentary member to extend completely through the transverse
tunnel such that the first end of the filamentary member extends
out from the first open end of the transverse tunnel and the second
end of the filamentary member extends out from the opposed second
open end of the transverse tunnel; pulling the top section of the
graft into the femoral tunnel by pulling on the needle and suture
such that the graft loop opening is in alignment with the
transverse tunnel; manipulating the filamentary member such that it
is tensioned to form a substantially straight configuration that is
substantially in alignment with the transverse tunnel; providing a
cannulated bone cross-pin having an outer surface; and, securing
the upper end of the graft loop in the femoral tunnel by passing
the cannulated cross-pin over the filamentary member and through
the graft loop opening, and mounting the cross-pin in the
transverse tunnel.
2. The method of claim 1 additionally comprising the steps of
providing a tibial securement member and securing the lower end of
the graft loop in the tibial tunnel by inserting the securement
member into the tibial tunnel.
3. The method of claim 1 wherein the cannulated cross-pin comprises
at least one section of threads on its outer surface.
4. The method of claim 1, wherein the cannulated cross-pin
comprises an absorbable polymer.
5. The method of claim 1, wherein the cannulated cross-pin
comprises a biocompatible metal.
6. The method of claim 1, wherein the cannulated cross-pin
comprises a biocompatible material selected from the group
consisting of allograft bone, autograft bone, ceramics and
composites.
Description
TECHNICAL FIELD
The field of art to which this invention relates is arthroscopic
surgical procedures, in particular, arthroscopic surgical
procedures for replacing an anterior cruciate ligament in the
knee.
BACKGROUND OF THE INVENTION
Arthroscopic surgical repairs of a ruptured anterior cruciate
ligament in the knee are known in this art. A rupture of the
anterior cruciate ligament ("ACL") is often seen in sports related
injuries. In a typical arthroscopic procedure, the surgeon prepares
the patient for surgery by insufflating the patient's knee with
sterile saline solution. Several cannulas are inserted into the
knee and used as entry portals into the interior of the knee. A
conventional arthroscope is inserted through one of the cannulas so
that the knee may be remotely viewed by the surgeon. The surgeon
then drills a tibial tunnel and a femoral tunnel in accordance with
conventional surgical techniques using conventional surgical drills
and drill guides. A replacement anterior cruciate ligament graft is
then prepared and mounted in the tibial and femoral tunnels, and
secured using conventional techniques and known devices in order to
complete the ACL reconstruction.
Several types of anterior cruciate ligament grafts are available
for use by the surgeon in ACL reconstruction procedures. The grafts
may be autografts that are harvested from the patient, for example
patellar bone-tendon-bone grafts, or hamstring grafts. Or the
grafts can be xenografts, allografts, or synthetic polymer
grafts.
There are various known methods for securing the femoral end of an
ACL graft in the femoral tunnel. The methods include, for example,
cross-pinning, and the use of femoral tunnel interference screws.
Of particular interest is a procedure wherein a cross-pin is used
to secure the graft in the femoral tunnel. When such a device is
used, a transverse tunnel is drilled into a section of the femur
such that it intersects the longitudinal femoral tunnel. When using
a conventional cross-pinning technique, the surgeon typically
prepares the graft by forming or folding it into a loop. Typically,
this step is preceded by whip stitching the ends of the graft in a
conventional manner. After the top end of the graft loop is
emplaced in the femoral tunnel, a cross-pin is then inserted into
the transverse tunnel and through the opening in the loop of the
graft underneath the top of the graft, thereby both securing the
graft in place in the femoral tunnel.
Although the existing methods of performing ACL reconstruction
using cross-pins are satisfactory for their intended purpose, and
provide the patient with the desired therapeutic result, there is a
constant need in this art for improved methods of performing ACL
graft reconstruction using cross-pins. In particular, one critical
aspect of a cross-pinning method is the ability to place a graft in
a femoral tunnel such that when the cross-pin is inserted through
the transverse tunnel, the pin is precisely placed in the opening
of the graft loop below the top of the graft loop. It can be
appreciated by those skilled in this art that placement of the
cross-pin above the top of the graft loop will result in the graft
not being adequately secured in the femoral tunnel, with the
likelihood of a catastrophic failure. Precise placement of a
cross-pin into the opening of a graft loop is presently
accomplished in this art by using guide wires and cannulated
cross-pins that are inserted over the guide wires. In one known
method, a guide wire consisting of a flexible filamentary member is
actually looped through the transverse tunnel and down through the
femoral and tibial tunnels, such that an end extends out through
both sides of the transverse tunnel, and a bottom loop extends out
through the bottom of the tibial tunnel. A graft is folded to form
a graft loop and placed about the bottom loop of the guide wire
such that the guide wire runs through the graft loop opening. The
ends of the guide wire extending out through the openings of the
transverse tunnel are tensioned to pull the guide wire and graft up
through the tibial and femoral tunnels into a desired position for
fixation, and a cannulated cross-pin is then threaded over the
guide wire and mounted in the transverse tunnel to secure the upper
part of the graft loop in the femoral tunnel. Although this method
succeeds in emplacing a graft in the femoral tunnel and securing it
with a cross-pin, there are disadvantages associated with its use.
For example, it requires that the graft be pulled longitudinally
through the tibial and femoral tunnels by pulling transversely on
the flexible filamentary member ends that exit the sides of the
transverse tunnel. This may result in damage to the bone
surrounding the interiors of the femoral and transverse tunnels. In
addition, it can be a lengthy and time-consuming process since it
is inefficient to move a graft longitudinally through a tunnel by
pulling transversely on the flexible filamentary member.
Accordingly, there is a need in this art for improved methods of
ACL knee reconstruction using cross-pins.
SUMMARY OF THE INVENTION
It is an object of the present invention to provide a novel method
of performing an ACL reconstruction using a cannulated cross-pin,
wherein a filamentary member is provided as a guide for the
cross-pin, and an ACL graft is pulled into the tibial and femoral
tunnels using a surgical needle and attached surgical suture.
Therefore, a method for repairing a knee arthroscopically using an
anterior cruciate ligament replacement graft is disclosed. The
method consists of providing an anterior cruciate ligament
replacement graft that is formed into a loop having a top and a
bottom. The loop has an opening. A longitudinal tibial tunnel is
drilled through a top of a tibia adjacent to the knee, the tibial
tunnel has top and bottom openings. A longitudinal femoral tunnel
is drilled through the bottom section of an adjacent femor such
that the tibial tunnel and the femoral tunnel are substantially in
alignment. The femoral tunnel has opposed top and bottom openings.
A substantially transverse tunnel is drilled through the femoral
tunnel such that the transverse tunnel intersects the femoral
tunnel and is in communication therewith, the transverse tunnel has
opposed first and second openings. A filamentary member is
provided. The filamentary member is an endless loop. The
filamentary member is threaded through knee such that a first end
loop of the filamentary member extends out from a first side of the
transverse tunnel, continues through the femoral and tibial
tunnels, and a second end loop extends out through the bottom
opening of the tibial tunnel. A surgical needle and suture are
provided. The suture is mounted to the surgical needle such that a
suture loop is formed. The graft is engaged with the suture loop
such that the suture passes through the graft loop opening. And,
the graft is also engaged with the second end loop of the
filamentary member such that the filamentary member passes through
the graft loop opening. The needle and suture are moved into the
tibial tunnel and femoral tunnel. The graft loop is pulled into and
partially out of the tibial tunnel by pulling on the needle and
suture, such that the top of the graft loop is located outside of
the top opening of the tibial tunnel and adjacent to the bottom
opening of the femoral tunnel. The needle and suture move out
through the top opening of the femoral tunnel. The filamentary
member simultaneously moves with the graft as the suture is pulled.
The second end loop of the filamentary member is also located
outside of the top opening of the tibial tunnel adjacent to the
bottom opening of the femoral tunnel. The first end loop of the
filamentary member is then cut to form first and second ends. The
first end of the filamentary member is maintained outside of the
first opening of the tibial tunnel, and the filamentary member is
manipulated to extend through the transverse tunnel with the second
end of the filamentary member extending out through the second
opening of the transverse tunnel. The suture is then tensioned to
move the top of the graft loop and the second end loop of the
filamentary member into to femoral tunnel such that the graft loop
opening is in substantial alignment with the transverse tunnel. The
filamentary member is tensioned to form a substantially straight
configuration that is substantially in alignment with the
transverse tunnel. A cannulated cross-pin is provided. The upper
end of the graft loop is secured in the femoral tunnel by passing
the cannulated bone pin over the filamentary member and mounting
the bone pin in the transverse tunnel. The lower end of the graft
loop may be secured in the tibial tunnel by inserting a securement
member or device into the tibial tunnel, e.g. an interference
screw, thereby completing the reconstruction.
These and other aspects, advantages of the present invention, will
become more apparent from the following drawings and accompanying
description.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is an illustration of a human knee having a ruptured
anterior cruciate ligament.
FIG. 2 is an illustration of the knee of FIG. 1 having tibial and
femoral tunnels drilled in the tibia and femor respectively, and
illustrating a drill guide mounted to the knee for drilling a
transverse tunnel in the femor to receive a cross-pin.
FIG. 3 illustrates an instrument for inserting a looped filamentary
member into the tibial and femoral tunnels.
FIG. 4 illustrates the distal end of the loop insertion instrument
in the femoral tunnel with a passing pin inserted into the
transverse tunnel.
FIG. 5 illustrates the passing pin capturing a looped segment of
the filamentary member from the loop insertion instrument as the
loop insertion instrument is withdrawn from the femoral tunnel.
FIG. 6 illustrates the distal end of the passing pin extending out
through one end of the transverse tunnel, and the loop segment
exiting the transverse tunnel.
FIG. 7 illustrates the knee with a surgical suture loop threaded
through the tibial and femoral tunnels, and a graft looped segments
of the filamentary member and the suture extending out from the
bottom of the tibial tunnel; the passing pin has been moved
laterally in the transverse to a side of the femoral tunnel.
FIGS. 8a-c illustrates the graft moved into a position extending
out from the tibial tunnel adjacent to the entrance to the tibial
tunnel, with the top loop segment being cut with surgical scissors
and one end being threaded into openings in the passing pin
member.
FIG. 9 illustrates the passing pin moved through the transverse
tunnel, with the looped segment cut and having a first cut end
mounted to the distal end of the passing pin prior to moving the
passing pin and end through the transverse tunnel, while the second
cut end is free.
FIG. 10 illustrates the first and second ends of the filamentary
member exiting opposite sides of the transverse tunnel with a
bottom loop segment extending out through the bottom opening of the
femoral tunnel with the top of the graft adjacent to the bottom
opening of the femoral tunnel; the passing pin has been removed
from the transverse tunnel.
FIG. 11 illustrates a section of the suture exiting the femoral
tunnel with the graft member moved into and positioned within both
the femoral and tibial tunnels, having the top end of the graft
emplaced in the femoral tunnel such that the graft loop opening
adjacent to the transverse tunnel. Also shown is the filamentary
member being tensioned to straighten and align it with the
transverse tunnel to serve as a guide wire.
FIG. 12--illustrates a cannulated cross-pin inserted over the guide
wire and partially inserted into the transverse tunnel.
FIG. 13 illustrates the cross-pin partially inserted with the
distal end in the graft loop opening and underneath the top of the
graft loop.
FIG. 14 illustrates the cannulated pin completely screwed into
place and engaging the graft and securing the upper end of the
graft in a substantially fixed position in the femoral tunnel.
FIG. 15 illustrates the knee after the top end of the end of the
graft has been secured in the femoral tunnel and the guide wire
removed, and with the bottom end of the graft secured in the tibial
tunnel using an interference screw, thereby completing the ACL
replacement surgical procedure with the ACL replacement graft
secured in both the femoral and tibial tunnels to provide for a
reconstructed ACL.
DESCRIPTION OF THE INVENTION
The terms "anterior cruciate ligament" and the acronym "ACL" are
used interchangeably herein.
Referring now to FIGS. 1-15, the novel surgical method of the
present invention of replacing a ruptured anterior cruciate
ligament to reconstruct a knee is illustrated. FIG. 1 illustrates a
typical patient's knee 5 prior to the onset of the surgical
procedure. Illustrated is the top 15 of the tibia 10, the top 21 of
the fibula 20, the bottom 61 of the femur 60, as well as the
condylar notch 65. The posterior collateral ligament 50 is seen to
be present in the knee 5. Also seen at the top 15 of the tibia 10
the meniscal cartilage 22.
As seen in FIG. 2, after preparing the patient's knee 5 using
conventional arthroscopic surgical procedures, a tibial tunnel 40
is drilled in a conventional manner through the top 15 of the tibia
10 to create tibial tunnel 40. Tibial tunnel 40 has passage 41
having lower opening 43 and upper opening 45. The tibial tunnel 40
is drilled using a conventional two-step process with an initial
pilot guide drill followed by a subsequent coring reamer to create
the tibial tunnel 40 having passage 41. Preferably, the tibial
tunnel is positioned in the posterior one-half of the normal
attachment site of the ACL. The tunnel 40 is typically debrided of
all surrounding debris at lower opening 43 and upper opening 45,
and any sharp edges are chamfered using a conventional bone rasp.
Next a conventional offset femoral aiming device (not shown) is
inserted through opening 43 and into the tibial tunnel 40 such that
the distal end of the femoral aimer device extends out through the
opening 45 at the top of the tunnel 40, and the distal end of the
femoral aimer device engages a suitable position on the superior
rim 66 of the condylar notch 65. Then a guide pin can be drilled up
through the notch 65 and out of the anterior cortex 67 of the femur
60. Next a femoral tunnel 90 is reamed out using a conventional
surgical reamer to accommodate the graft diameter. The femoral
tunnel 90 is seen to have bottom opening 91, passage 95 and top
opening 92. The tunnel is seen to have internal step 93 where the
passage 95 transitions between first diameter 96 and second
diameter 97. The tunnel 90 is typically debrided of all surrounding
debris at bottom opening 91 and top opening 92, and any sharp edges
are chamfered using a conventional bone rasp.
Next, a transverse femoral drill guide 120 is mounted to the tibia
10 and the femur 60. The drill guide 120 is seen to have "L" shaped
frame 122 having bottom leg 126 and perpendicular top leg 128. The
drill guide 120 is seen to have longitudinal drill guide 130
mounted to the bottom leg 126 and horizontal drill guide 140
mounted to the top leg 128. The longitudinal drill guide 130 is
positioned within the tibial and femoral tunnels 40 and 90,
respectively. A partial incision 141 is made in the skin and the
tissue thereunder is bluntly bisected to the lateral femoral cortex
68. The drill guide 140 is advanced to contact the lateral femoral
condyral 69. Next, a drill 145 is inserted into the transverse
drill guide 140 and the transverse tunnel 150 is drilled
transversely through the femoral end 61. The distal end section 132
of the longitudinal drill guide 130 contains an opening 134 to
receive the drill 145 to provide for appropriate alignment. The
tunnel 150 is seen to have passage 155, and opposed end openings
151 and 152. The knee 5 is now ready to have the replacement ACL
graft implanted.
The types of ACL implants that can be used in the method of the
present invention include autografts, allografts, xenografts and
synthetic grafts. Autografts consists of the patients own
ligamentous tissue harvested either from the patellar tendon or
from the tendons of the hamstring. Allografts include ligamentous
tissue harvested from cadavers and appropriately treated and
disinfected, and preferably sterilized. Xenografts include
harvested connective tissue from animal sources such as, for
example, porcine tissue. Typically, the xenografts must be
appropriately treated to eliminate or minimize an immune response.
Synthetic grafts include grafts made from synthetic polymers such
as polyurethane, polyethylene, polyester and other conventional
biocompatible bioabsorbable or nonabsorbable polymers and
composites. The grafts 200 are typically prepared in a conventional
manner, optionally whip stitching the ends 212 of the graft with
surgical sutures 220, and folding the graft over by bringing the
ends 212 together to form a loop of graft material having a bottom
215, a loop top 222 and a loop opening 225 as seen in FIGS.
9-14.
The filamentary members 180 that may be used in the practice of the
present invention include any type of flexible, strong
biocompatible material. The filaments may be a single unitary fiber
or may be of multi-filament construction, for example, braided or
woven. The filaments may be made from nylon, polypropylene,
polyethylene, polyester, braided, woven and twisted metal and/or
malleable alloys and combinations thereof. In a particularly
preferred embodiment, the filamentary member 180 is made from
nylon. The filamentary member 180 may be precut with two opposed
ends, or may be in the form of an endless loop. It is particularly
preferred in the practice of the present invention to utilize the
filamentary member in the form of an endless loop that is later cut
to provide a filamentary member with two ends.
When using a filamentary member 180 in the surgical method of the
present invention it is preferably used in the form of an endless
loop (see FIGS. 3-11). The filamentary member is loaded on to an
inserter instrument 240 having a proximal handle 242 and a distal
notched end 244 for engaging the loop. The distal notched end 244
of the inserter 240 having the filamentary member 180 mounted
thereto is then inserted into the bottom opening 43 of the tibial
tunnel 40 and the instrument is moved forward through the passage
41 of tibial tunnel 40, out of upper opening 45, through bottom
opening 91 of femoral tunnel 90 and into the passage 95 of femoral
tunnel 90 adjacent to the intersection with the transverse tunnel
150. Then, a passing pin member 250 is inserted into opening 152 of
the transverse tunnel. The passing pin 250 is seen to have a notch
252 for receiving and engaging a section of the filamentary loop
member 180. The passing pin 250 is seen to pass through opening 246
in notched end 244. Once a section of the member 180 is engaged or
captured in the notch 252, the inserter member 240 is withdrawn
from the femoral and tibial tunnels 40 and 90, respectively, and
the shuttle instrument 250 is moved laterally until the notch 252
and the engaged section of the filamentary member 180 exits opening
151 of the transverse tunnel 150. At that time, the first top loop
section 185 of member 180 is removed from the notch 252 by the
surgeon and is maintained outside of opening 151. the bottom loop
section 187 of the filamentary member 180 is seen to extend down
out through the bottom of the tibial tunnel 40 through opening 43.
A surgical suture 260 is then used to move the graft 200 into place
in the tibial and femoral tunnels 40 and 90, respectively. The
surgeon loops or folds the graft 200 through the opening 266 of
suture loop 265 of suture 260 connected to the proximal end 282 of
the straight surgical needle 280. Needle 280 has distal end 285.
The suture passes through the eyelet 283 of the needle 280. At the
same time the tendon graft 200 is also looped through the opening
186 of bottom section loop 187 of the filamentary member 180. The
surgeon then pulls the straight surgical needle 280 up in the
direction along the longitudinal axes of the femoral and tibial
tunnels 40 and 90, respectively, such that the needle 280 exits the
femoral tunnel 90 through top opening 92, and the suture loop pulls
the distal or top end 222 of the graft loop 200 out of the tibial
tunnel and adjacent to opening 91 of femoral tunnel 90. As the
suture 260 pulls the distal end 222 of the graft 200 into and out
of the tunnel 40, the looped end 185 of the filamentary member 180
also moves with the top end 222 of graft 200 into the space
adjacent to the opening 91 of femoral tunnel 90.
Next, the surgeon cuts the top loop section 185 with conventional
surgical scissors 400 to form ends 181 and 182. End 182 of the
member 180 is then threaded into the eyelets 256 and the passing
pin member 250 is moved horizontally in the opposite direction
through passage 155 of transverse tunnel 150 exiting the transverse
tunnel through opening 152 on the opposite side of tunnel 150 such
that the end 182 also exits the tunnel, and the ends 181 and 182 of
the filamentary member 180 exit through opposite sides of the
transverse tunnel 150 (through openings 151 and 152, respectively).
The passing pin member 250 is removed from the transverse tunnel
150. Needle 280 and suture 260 are then tensioned and moved through
femoral tunnel 90 such that the top section of graft 200 is moved
into femoral tunnel 90 and the graft top end 222 is located in the
femoral tunnel 90 in a fixation position, with opening 225 in
alignment with passage 155. The ends 181 and 182 of the filamentary
member 180 are tensioned to place the filamentary member 180 in a
straight configuration to serve as a guide wire through transverse
tunnel 150 and through graft opening 225 for a conventional
cannulated cross-pin.
Referring now to FIGS. 12-15, the cross-pin 300 is seen to have
lumen 305 and threaded bone engaging section 307. The end 181 of
the filamentary member 180 is threaded through lumen 305 of
cannulated cross-pin 300, and secured in the handle 325 of the
driving instrument 320 by attachment to the optional bead member
330 having passages 332 for receiving the end 181. Bead member 330
is mounted to the end of handle 325. The other end 182 of the
filamentary member 180 is placed in tension by the surgeon while
the surgeon screws the cross-pin into the tunnel 150 underneath the
top 222 of the graft loop 200 and through opening 225 thereby
securing the upper section of the graft 200 in the femoral tunnel
90. The surgeon then removes the driving instrument 320 from the
cross-pin 300, and removes the instrument 320 and filamentary
member 180 from the transverse tunnel 150 and the cross-pinning
procedure is complete, with the top end 222 of the ACL replacement
graft 220 substantially secured or fixed in femoral tunnel 90.
Shown if FIG. 11 is the optional depth stop sleeve 390 used to
assure the surgeon that the threads 307 are flush against the
lateral femoral cortex 68 or slightly buried.
The surgeon then affixes the bottom end 215 of the graft 200 in the
tibial tunnel 40 using a conventional securing device such as an
interference screw 340, or other conventional devices such as
tibial fasteners, screws and washers, etc. The ACL replacement is
now complete, and the surgeon can remove the cannulas and close the
incisions about the knee using conventional incision approximating
techniques including sutures, tape, glue, staples, etc.
The cross-pins useful in the present invention can be made from a
variety of conventional biocompatible materials useful in implants.
The materials may be absorbable or non-absorbable. Examples of
conventional non-absorbable materials include surgical stainless
steel, nickel titanium alloys, ceramics, Delrin, polyethylene, and
other non-absorbable polymers including, but not limited to,
polypropylene, and Acetal. Examples of bioabsorbable materials
include PLA, PGA, polydioxanone, polycaprolactone, copolymers
thereof, and the like. The term "natural polymer" refers to
polymers that are naturally occurring, as opposed to synthetic
polymers. In embodiments where the device includes at least one
synthetic polymer, suitable biocompatible synthetic polymers can
include polymers selected from the group consisting of aliphatic
polyesters, poly(amino acids), copoly(etheresters), polyalkylenes
oxalaes, polyamides, tyrosine derived polycarbonates,
poly(iminocarbonates), polyorthoesters, polyoxaesters,
polyamidoesters, polyoxaesters containing amine groups,
poly(anhydrides), polyphosphazenes, polyurethanes, poly(ether
urethanes), poly(ester urethane) and blends thereof. Suitable
synthetic polymers for use in the present invention can also
include biosynthetic polymers based on sequences found in collagen,
elastin, thrombin, fibronectin, starches, poly(amino acid),
poly(propylene fumarate), geletin, alginate, pectin, fibrin,
oxidized cellulose, chitin, chitosan, tropoelastin, hyaluronic
acid, ribonucleic acids, deoxyribonucleic acids, polypeptides,
proteins, polysaccharides, polynucleotides and combination thereof.
The devices of the present invention may also be manufactured from
conventional biocompatible natural polymers. If desired, the
bioabsorbable materials may contain osteoinductive or
osteoconductive materials, polymers and blends of polymers
including but not limited to calcium hydroxyapatite, tricalcium
phosphate, and the like.
The cross-pins of the present invention may be made using a variety
of conventional manufacturing processes including machining,
molding, etc., and combinations thereof.
The novel anterial cruciate ligament replacement procedure of the
present invention has improvements over procedures known in the
art. In particular, the combination of the needle and suture to
pull the graft into the femoral tunnel along with the suture loop
filamentary member to provide for a transverse guide wire provides
efficiency in the placement of the top of the graft in the femoral
tunnel while minimizing or eliminating damage to the bone in the
transverse tunnel that could be caused by pulling up the graft
using the filamentary member. At the same time that the graft is
emplaced in the femoral tunnel, the filamentary wire is in place in
the transverse tunnel to serve as a guide wire for emplacing the
cross-pin in the transverse tunnel and through the opening in the
graft loop.
Although this invention has been shown and described with respect
to detailed embodiments thereof, it will be understood by those
skilled in the art that various changes in form and detail thereof
my be made without departing form the spirit and scope of the
claimed invention.
* * * * *